不同生物标志物在射血分数降低与射血分数保留的心力衰竭患者中的对比研究

Comparison of different biomarkers in heart failure with reduced and preserved left ventricular ejection fraction

目的探讨血清氮末端脑钠肽前体（NT-proBNP）、高敏C反应蛋白（hs-CRP）、胱抑素c（Cys-C）在射血分数降低的心力衰竭（HF-REF）与射血分数保留的心力衰竭（HF．PEF）中的表达水平及其之间的关系，探讨其临床价值。方法门诊收集106例心力衰竭（HF）患者，其中HF．REF患者58例（A组），HF-PEF患者48例（B组），测定两组患者血浆NT-proBNP、hs-CRP、Cys-C、肾功能、肝功能、血脂、左室射血分数等指标。横向比较NT-proBNP、Cys-C、高敏C反应蛋白等指标在两组中的浓度；分析两组中各HF指标的相关性。结果HF-REF患者与HF．PEF的患者体内NT-proBNP浓度和Cys-C浓度差异显著（P〈0．05），但hs-CRP未见明显差异（P〉0．05）；HF．REF患者中，NT-proBNP与hs．CRP和Cys-C均具有相关性，hs-CRP与Cys-C不具有相关性（γ=0．338，P=0．079）；在HF-PEF患者中，NT-proBNP与Cys-C有显著相关性（γ=0．429，P=0．041），与hs-CRP不具有相关性（γ=0．411，P：0．051），hs．CRP与Cys-C具有显著相关性（γ=0．834，P=0．000）。结论两种类型HF患者中HF标志物浓度不同。NT-proBNP在HF．PEF患者中可能没有HF．REF患者有用。

Objective To determine the serum concentrations of N-terminal pro-type （or brain） natriuretic peptide （NT-proBNP）, high sensitivity C-reactive protein （hs-CRP） and cystatin C （Cys-C） in the patients with reduced ejection fraction heart failure （HF-REF） or with preserved ejection fraction heart failure （HF-PEF） and investigate their relationship for clinical value. Methods A total of 106 outpatients with established diagnosis of heart failure （HF） in our department from November 2012 to May 2013 were prospectively subjected in this study. There were 58 cases of HF-REF （group A） and 48 cases of HF-PEF （group B）. Blood samples were collected at their admission to determine the serum levels of NT-proBNP, Cys-C and hs-CRP, renal function, liver function, blood lipid, left ventricular ejection fraction （LVEF）, etc. A cross-sectional study was performed in the above serum concentrations of NT-proBNP, hs-CRP and Cys-C between these 2 groups, and a correlation analysis was carried out on their heart failure indices. Results The serum levels of NT-proBNP and Cys-C were significanctly higher in the patients with HF-REF than in those with HF-PEF （both P 〈 0.05）, but no significant difference was seen in the level of hs-CRP （P 〉 0.05）. In patients with HF-REF, NT-proBNP was correlated with hs-CRP （γ= 0.482, P = 0.009） and Cys-C （γ= 0.450, P = 0.014）, while hs-CRP was not correlated with Cys-C （γ= 0.338, P= 0.079）. In patients with HF-PEF, NT-pro BNP was only correlated significantly with Cys-C （γ= 0.429, P= 0.041）, but not with hs-CRP （γ= 0.411, P= 0.051）, while hs-CRP was correlated with Cys-C （γ = 0.834, P= 0.000）. Conclusion The serum concentrations of HF biomarker are different between HF-PEF and HF-REF patients. NT-pro BNP may be less useful in HF-PEF than in HF-REF.